Hello everyone, and welcome to our Minute. Today I want to share with you a brief update on the VBID model for Hospice being included and the Medicare Advantage Organization plans that have volunteered to participate in this VBID demonstration. The VBID model officially began 2021 and there were nine Medicare Advantage organizations that participated with 52 plans, including the hospice benefit. In 2022, there will be four more Medicare Advantage organizations that are going to be added, there’s technically one that will no longer be included and five that are being added. Within those Medicare Advantage organizations, there will be more than double the number of plans that were participating in the model in 2021, in 2022 there will be 115 plans participating in the model. The model will be active in 22 states and the territory of Puerto Rico with this VBID model. Basically, if you as a hospice, are admitting a patient and you go to check the Medicare eligibility of that patient and determine that that patient is on a Medicare Advantage Plan, you are going to need to immediately check the eligibility verification of that patient to ensure who the payer is. If you have identified that that patient is participating in a Medicare Advantage plan, you are going to have to go through the process of determining whether that patient is in a Medicare Advantage plan that is indeed participating in the demonstration. CMS has given a detailed list on the VBID page of their website of all of the participating organizations, the states that those organizations will be active in with the clients that are participating, and contact information, so that you will have a contact name and number to contact them with additional questions that you might have about their participation.
The one thing that must be clear about the VBID model is that hospices themselves do not have an option as to whether or not they participate. If you accept a patient, that is a part of one of the Medicare Advantage plans that is participating in the model, then you have no choice but to participate in the model. You also need to make sure you are very clear that as a Medicare Certified Hospice if you do accept a patient that their plan is participating in the model, you will be required to bill traditional Medicare and the Medicare Advantage plan, both with a notice of election and the monthly claims. You are also required to file the notice of termination revocation with both if that patient is discharged live. It is extremely important that you understand the risk that you have if you do not identify that you are treating a patient that is participating or is in a plan that is participating in the model. You do need to make sure you have followed all the steps if you are not in-network with a Medicare Advantage organization. They cannot, at this point, require the patient to participate or to elect services with an in-network provider and as an out of network provider, you are to be paid the traditional Medicare rates for that hospice patient. The Medicare Advantage organizations are required to cover all levels of care that the traditional Medicare benefit currently covers.
We will include some links in the details of this Minute to give you additional information about VBID make sure that you are really clear regarding the process that needs to be adhered to, if you do in fact admit a patient that is in one of these plans.
Medicare Advantage Value-Based Insurance Design Model
Thank you so much for participating today. And we look forward to being with you again soon.